Provider Demographics
NPI:1326823345
Name:SERRANO, JOSE III (RDN)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:SERRANO
Suffix:III
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 W 121ST ST
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-3504
Mailing Address - Country:US
Mailing Address - Phone:213-448-6157
Mailing Address - Fax:
Practice Address - Street 1:4920 W 121ST ST
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3504
Practice Address - Country:US
Practice Address - Phone:213-448-6157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86175164133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered